Individualized Myopia Control needed Considering Binocular and Accommodative Effects: Study

Although myopia is a leading cause of distance vision impairment worldwide, earlier research has established a strong link between its onset and binocular vision disorders; however, there is a distinct clinical gap regarding how different control interventions impact these functions, prompting Shobha Gupta of the Chitkara School of Health Sciences at Chitkara University and Nayan Gupta from the Department of Optometry at Galgotias University to conduct the review to clarify these complex relationships.

Therefore, the narrative review utilized a structured literature search conducted across PubMed and Google Scholar using Boolean operators and keywords such as "vergence" and "accommodative” convergence to the accommodation (AC/A) ratio to evaluate a study population consisting of both children and adults. The researchers assessed 69 full-text articles and ultimately included 28 core original and review studies in their analysis, focusing on primary endpoints like accommodative lag and near phoria while excluding studies that did not directly address the intersection of myopia control and binocularity. Their methodology compared several key interventions, including highly aspherical lenslets (HALs), defocus incorporated multiple segments (DIMS) spectacle lenses, and pharmacological agents over various treatment durations to provide a comprehensive clinical overview.

Key Clinical Findings of the Narrative Review Include:

• Orthokeratology Adaptations: The review showed that OK significantly reduced accommodative lag by -0.58±0.57 in pediatric patients after one month and increased negative fusional vergence (NFV) from 2.6 to 3.3 prism diopters, suggesting it effectively manages myopia while neutralizing binocular imbalances.

• Aspherical Lenslet Dynamics: The review noted that HALs and slightly aspherical lenslets (SALs) led to a significant increase in accommodative microfluctuations (AMFs) to 0.19±0.07 diopters (D) and 0.17±0.05 D, respectively, compared to 0.13±0.07 D for single-vision lenses (SVLs) after a 12-month period.

• DIMS Visual Function: The review found that DIMS lenses resulted in no statistically significant difference in accommodative response compared to SVLs, yet they provided a significant improvement in stereo acuity scores (P<0.001) over a two-year duration.

• Pharmacological Consistency: The review demonstrated that low-concentration 0.01% atropine remains one of the most effective interventions with a negligible impact on near blur, maintaining stable AC/A ratios and showing only a minor decrease in accommodative amplitude of 4.4 ± 4.9 D per year.

• Contact Lens Shifts: The review identified that multifocal contact lenses (MFCLs) often cause a shift toward exophoria at near distances, with findings showing -2.06±2.49 prism diopters of exophoria at 40 cm compared to -0.41±2.91 prism diopters in standard single-vision contact lenses.

The results suggest that while interventions like orthokeratology and specialized spectacle lenses can reduce myopia progression by approximately 50% to 67%, these modalities frequently induce changes in the binocular system such as increased exophoric shifts and altered microfluctuations. Consequently, the data emphasizes the necessity for practitioners to manage both the progression of the refractive error and the associated binocular vision anomalies simultaneously to ensure long-term clinical success.

Thus, the review concludes optometrists and ophthalmologists should consider the potential for accommodative and binocular disruptions when prescribing specific myopia control modalities to better tailor treatments to individual patient needs.

While the review provides strong evidence for specific interventions, the presence of mixed outcomes in soft multifocal contact lens studies suggests that future research could further explore the long-term impact of varying lens designs on binocular stability.

Reference

Gupta S, Gupta N. Impact of myopia and myopia control interventions on binocular vision: A narrative review. Indian J Ophthalmol 2026;74:486-91.